Treatment of Diabetic Neuropathy - Current Possibilities and Perspectives

Diabetic neuropathy (DN), characterized by nerve damage associated with diabetes mellitus, belongs among the earliest and most frequent chronic diabetic complications. It may occur in clinical form (as peripheral sensory/motor, autonomic, proximal, painful or focal) or in subclinical form detectable just by sensitive diagnostic methods. The etiology of DN is complex and not fully understood, untill now. Longterm hyperglycemia triggers a variety of interacting pathways such as production of advanced glycation end products (AGEs), products of oxidative stress and polyol pathway, protein kinase C activation, decrease activity of Na+K+ATP-ase, changed concentration of neural growth factor and production of proinflammatory cytokines. These pathomechanisms may target directly on nerve cells or on endothelial cells causing the microangiopathy of vasa nervorum.

According to multicentric studies, duration and poor compensation of diabetes are the principal risk factors associated with the development of chronic diabetic complications, so the basis for the management is to maintain adequate metabolic compensation. Intensified insulin regimen is the most effective in the treatment of patients with type 1 diabetes. In patients with type 2 diabetes, administration of selected peroral antidiabetics or insulin therapy is considered. Physical activity, lifestyle and dietary management also contribute to euglycemia. Currently used management of DN includes supportive (alpha-lipoic acid, vitamins, antioxidants) and symptomatic treatment (painkillers, beta blockers, magnetotherapy). Other therapeutic possibilities are experimental so far. These drugs interfere with the pathophysiological processes and few of them have been shown to be beneficial in clinical studies (inhibitors of aldose reductase, selective inhibitor of protein kinase C beta, C peptide substitution), however, the effect of other medicines seems to be controversial (vascular endothelial growth factor, erythropoietin). This chapter brings comprehensive review about current possibilities and future perspectives in the management of diabetic neuropathy.

Keywords: Actovegin, Aldose-reductase inhibitors, Alpha-lipoic acid, Angiotensin converting enzyme inhibitors, Anti-inflammatory drugs, Antioxidants, Chronic complications, C-peptide, Diabetes compensation, Diabetes mellitus, Diabetic neuropathy, Electrical nerve stimulation, Epigenetic modifications, Erythropoietin, Experimental studies, Growth factors, Kinin B1 receptor, Management, Magnetic field therapy, Neurotrophic factors, Pain relief, Ruboxistaurin, Spinal cord stimulation, Vascular endothelial growth factor, Vitamins.